gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Chronic intramedullary abscess: a case report and review of the literature

Meeting Abstract

  • corresponding author R. Seizeur - Service de Neurochirurgie, Hôpital Foch, Suresnes, France
  • S. Gaillard - Service de Neurochirurgie, Hôpital Foch, Suresnes, France
  • S. Goutagny - Service de Neurochirurgie, Hôpital Foch, Suresnes, France
  • S. Auliac - Service de Neurochirurgie, Hôpital Foch, Suresnes, France
  • P. Pencalet - Service de Neurochirurgie, Hôpital Foch, Suresnes, France
  • A. Visot - Service de Neurochirurgie, Hôpital Foch, Suresnes, France

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocP105

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0373.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Seizeur et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Intramedullary spinal cord abscesses are very rare. We present here a new case of this pathology, revealed by a progressive spinal cord compression. This case is particular because of the long follow-up before the surgery (two years).

Methods

This sixty eight years old patient has presented a gradually progressive paraparesis and sensory loss associated with legs pain. The past medical history was dominated by a tongue epidermoid cancer treated by surgery and radiotherapy. The MRI has shown an intramedullary mass lesion at the T10 level (8 mm). At T1-weighted sequences, the lesion was isointensive with the spinal cord, gadolinium infusion showed a homogeneous enhancement of the lesion. T2-weighted sequences showed decreased signal of the lesion with increased signal around (edema).

The others investigations gave no more information, particularly the lumbar puncture were normal. Corticoid infusions relieved the symptomatology so the patient refused the operation. Two episodes of regressive paraplegia with sphincter disturbances were treated by the same infusions. The patient has accepted the intervention with the third episode. The MRI realised after each episode, the only modification is edema which increase with the deficit and decrease after corticoid infusions.

Results

The intervention was performed two years after the first signs. We find a hard white mass lesion griped to the spinal cord. Pathologic examination showed infectious inflammation with acute and chronic micro-abscesses. Bacteriological cultures found a Streptococcus sanguis. This bacterium came from pathological teeth.

The initial out comes showed an intestinal perforation (Ogilvi syndrome). After this episode the patient could walked and one and half year later a minimal deficit persists.

Conclusions

First, the diagnosis was evoked but no retain because of the long evolution. The corticoid infusions gave a benefit and never increase the deficit. The MRI images were the same along two years except edema.

Intramedullary spinal cord abscesses are very rare. It’s very important to this pathology because of the morbidity and possible death without treatment. The evolution of our patient is very particular because of the symptomatology regression and non modified MRI images in spit of adequate treatment before surgery.